Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Physical Medicine and Rehabilitation 10 Gait PPT-Powerpoint Presentations and lecture notes
GAIT: NORMAL, ABNORMAL
& ASSESSMENT
GAIT
1- Normal Walking
2- Gait cycle ? phases, temporal parameters
3- Determinants of gait
4- Kinematic & kinetic analysis
5- Gait in young, elderly & women
6- Some abnormal gaits
7- Assessment ? visual, video recording
8- Clinical Gait laboratory
Walking
Walking
- complex interaction of different parts of body
- it's advancement in the desired line of progression.
Muscle act - this motion and forces are controlled
Normal walking ?
- weight bearing stability and
- progression over the supporting foot
- optimal conservation of physiologic energy.
GAIT CYCLE :- Activity that occurs between heel
strike of one extremity and subsequent heel strike
same side.
STANCE PHASE :- Phase in which limb is in contact
with the ground. (60%)
SWING PHASE :- Phase in which the foot is in air for
limb advancement. (40%)
DOUBLE SUPPORT: When two extremities are in
contact with the ground simultaneously
- cadence (speed of walking) - double support
- Absence of double support - running
DEFINITIONS
Initial contact: (0%) Instant the foot contacts the
ground.
Loading response: (0-11%)
- immediately following initial contact - lift of C/L
extremity from ground
- weight shift occurs.
Subphases of Stance phase
Mid- stance: (11-30%)
- lift of C/L extremity from ground - ankles of both
extremities are aligned in the frontal (coronal) plane.
Terminal stance: (30-50%)
- ankle alignment in frontal plane - just prior to initial
contact of C/L extremity.
Preswing: (50-60%)
- initial contact of C/L extremity - prior lift of Ipsilateral
extremity from ground.
Sub phases of Swing phase
Initial swing: (60-73%) Lift of the extremity from
ground - position of maximum knee flexion.
Mid swing: (73-87%) Immediately following knee
flexion - vertical tibia position.
Terminal swing: (87-100%) Following vertical tibia
position - just prior to Initial contact.
Temporal Gait Parameters
Stride length: Linear distance between corresponding
successive points of contact of the same foot
- Highly variable - normalized by dividing it by leg
length or total body height
- increases as the speed increases.
Step length: opposite foot
- gait symmetry.
Cadence: No. of steps/minute
Velocity (meters/minute): Distance covered in given
time in the given direction.
Step width (width of walking base):
- Distance between the midpoints of the heel of two
feet
- increases - increased demand for side to side stability.
Degree of toe-out:
- Represents the angle of foot placement
- Angle between the line of progression and the line
intersecting the centre of heel and the second toe
- decreases as the speed increases
Temporal gait parameter
Average value
Velocity (m/s)
0.9 ? 1.5
Cadence (steps/min)
90 - 135
Stride length (m)
1 ? 1.5
Step length (cm)
38
Walking base (cm)
6 - 10
Degree of toe-out
7?
Stance phase
60%
Swing phase
40%
Double limb support
20%
Determinants of Gait (Saunders 1953)
Optimizations to minimize excursion of centre of
gravity (COG), hence reduction of energy consumption
1. Pelvic rotation
2. Pelvic tilt
3. Knee flexion in stance
4. Ankle PF
5. Foot supination
6. Lateral displacement of the pelvis
?
Determinants 1 - 5 reduce displacement on the
vertical plane (50%)
?
determinant 6 - horizontal plane (40%).
GROUND REACTION FORCE (GRF)- When a person
takes a step, forces are applied to the ground by the
foot and by the ground to the foot (GRF)
- equal but opposite
- GRFVector = sum of the force components in each
direction (vertical, anteroposterior and mediolateral
axes)
- typical pattern from initial contact to toe-off.
MOMENTS (Torque/ turning force)-
External forces - GRF, gravity and inertia - external
moments about the joints.
Internal moments - moments generated by the
muscles, joint capsules, and ligaments - countract the
external forces
Muscle activity
Kinetics and Kinematics
Kinetics : Study of forces, moments, masses and
accelerations, but without any detailed knowledge of
the position or orientation of objects involved.
Kinematics : Describes motion, but without reference
to forces involved.
Trunk and Shoulder
Trunk along with shoulder girdle twists in opposite
direction of pelvic twist
Total excursion of trunk is 7? and pelvic girdle 12?.
Total ROM of shoulder is 30? (24? of extension and 6?
of flexion)
Center of gravity (COG) is located 5 cm anterior to
second sacral vertebra
It is displaced 5 cm horizontally and 5 cm vertically
during a gait cycle.
Gait in children
Children have no heel strike, initial contact being
made by flatfoot (2 yr)
Very little stance phase knee flexion (2 yr)
Whole leg is externally rotated during swing phase (2
yr)
Walking base is wider (4 yr)
Absence of reciprocal arm swing (4 yr)
Stride length and velocity are lower and cadence
higher (15 yr)
GAIT IN ELDERLY
Decreased stride length and cadence
Increase in walking base
Reduction in total range of flexion and extension of
joints
GAIT IN WOMEN
Gait speed is slower
Step length is smaller
Increased cadence
ABNORMAL GAIT
Any deviation from normal pattern of walking
Caused
- motor system
- skeletal supports
- neural control
- combination of the above.
PAINFUL/ANTALGIC GAIT HIGH STEPPAGE GAIT
Avoidance of weight bearing
weakness of ankle
on the affected limb
dorsiflexors
shortening of stance phase in
excessive knee and hip
that limb
flexion with toes pointing
downwards in the swing
phase
VAULTING
Seen in limb length
discrepancy, hamstring
weakness or extension
contractures of the knee
The knee is hyper-
extended and locked at
end of stance phase and
entire swing phase.
So to clear the leg the
patient goes up on the toes
of the other leg to clear the
affected limb.
TRENDELENBURG GAIT
The gluteus medius during
the stance phase, pulls the
stance side pelvis over the
supporting limb to prevent
excessive pelvic drop in the
opposite swing limb.
If the hip abductors are
weakened, the opposite limb
pelvis may drop excessively
during swing phase.
To avoid this, the entire
trunk shifts to the stance side
to bring the stance pelvis on
to the supporting limb.
This is known as gluteus
medius lurch or
trendelenburg gait.
MYOPATHIC GAIT
If both hip abductors are
weak, the trunk sways
from side to side during
the stance phase to bring
the pelvis level on the
supporting limb.
waddling gait.
muscular dystrophies
accompanied by excess
lumbar lordosis to
compensate for hip
extensor weakness.
HEMIPLEGIC GAIT
In extensor synergy -
?heel strike is missing and patient lands on forefoot
?Since hip and knee are kept extended throughout the
gait cycle, there is relative limb lengthening and
hence circumduction or hip hiking is used for
clearance
?Toe drag may be present in swing phase
?Swing phase is longer on the affected limb
?Decreased arm swing on the affected side.
If flaccid paralysis or flexor synergy is present
?knee buckling and instability
FESTINATING/PROPULSIVE
GAIT
Lack of arm swing
Short, quick steps with
increasing speed
Cannot stop abruptly or
change directions
Stooped posture
Seen in
Parkinsonism
Carbon monoxide
poisoning
ATAXIC GAIT
Seen in cerebellar lesions
Dysmetria and inco-
ordination
Staggering and lack of
smooth movements
(reeling or drunken gait)
Falls to the side of lesion
Compensated by wide-
based gait to increase
base of stability
STOMPING GAIT
Seen in sensory ataxia
Gait with heavy heel strikes, forceful knee extension
and improper foot placement as well as a postural
instability
Usually worsened when the lack of proprioceptive
input cannot be compensated for by visual input, such
as in poorly lit environments.
Friedreich's ataxia, pernicious anemia, tabes dorsalis,
spinal cord pathologies
CEREBRAL PALSY GAIT
Crouch gait
?Hip and knee increased flexion throughout stance
with ankle dorsiflexion
?Due to hamstring tightness
Jump knee gait
?Flexion at hip and knee and ankle equinus is
characteristic of this gait
GAIT IN CEREBRAL PALSY
Stiff knee gait
?excess knee extension throughout swing
?Has to use circumduction or vaulting
?Due to increased rectus femoris activity in swing
phase
Recurvatum knee
?Due to triceps spasticity or hamstrings transfer
?Leads to increased knee extension in mid & late
stance
SCISSORING GAIT
Spasticity of the hip
adductors with relative
weakness of hip abductors
and secondary changes in the
hip gives rise to
rigidity and excessive
adduction of the leg in swing
plantar flexion of the ankle
increased flexion at the knee
adduction and internal
rotation at the hip
Diplegic CP, Spinal cord
pathologies
METHODS OF GAIT ANALYSIS
VISUAL GAIT ANALYSIS
The simplest form of gait analysis.
Look for:
Symmetry and smoothness of movements
Balance
Degree of effort
Motion of specific segments
Gait parameters
Gait should be observed from at least 3 angles (side,
front & back)
Limitations-
- gives no permanent record
- eyes cannot observe high-speed events
- only possible to observe movements not forces
- depends entirely on the skill of the individual observer.
Gait analysis walkway
- Length ? 10-12 m
- Width - visual - 3 m
video recording - 4 m
kinematic system - at least 6 m.
ANALYSIS BY VIDEO RECORDING
Advantages-
- gives permanent record
- can observe high speed events
- reduces the number of walks a subject needs to do
- makes it possible to show the subject exactly how they
are walking
- makes it easier to teach visual gait analysis to
someone else.
The majority of today's domestic cameras are perfectly
suitable for use in gait analysis
Clinical Gait laboratory
A fully equipped clinical
Equipment may also be
gait laboratory can be
available for measuring
expected to posses a
oxygen uptake or
combined
pressure beneath the
kinetic/kinematic
feet
systems, with
ambulatory EMG, as well
as facilities for making
videotapes.
KINEMATICS ?
- Camera by using infrared radiations measures the
position of the markers
FORCE PLATFORM / FORCEPLATE
- Usual methods of displaying force platform data is the
butterfly diagram
ELECTROMYOGRAPHY (EMG)
EMG measures the electrical activity of a contracting
muscle during different phases of gait cycle
1- Surface electrodes- Not suitable for deep muscles like
iliopsoas.
2- Fine wire electrodes-
3- Needle electrodes-
MEASURING ENERGY CONSUMPTION
Oxygen consumption-
- measurements of oxygen uptake
- while not particularly pleasant for the subject (who
has to wear face mask or mouth piece)
- Practical
Whole body calorimetry-
- most accurate way but quite impractical
- subject is kept in an insulated chamber for measuring
the heat output of the body
Physiological Cost Index: less accurate
PCI = (Walking HR ? Resting HR)
Walking Speed in m/min
Thank You.
This post was last modified on 08 April 2022